Case Manager Registered Nurse

About the role

The Care Manager, RN coordinates patient-centered care across the continuum, developing a safe discharge plan through collaboration with the patients/caregivers and multidisciplinary healthcare team. This role facilitates appropriate length of stay, patient experience, and reimbursement for all patients. It also involves facilitating patient and family education and promoting continuity of care.

Primary Responsibilities

• Effectively problem-solves and actively pursues resolution
• Directly communicates with staff, physicians, patients, and families
• Models leadership behavior through courtesy, respect, and efficiency
• Coordinates patient care processes to achieve desired quality outcomes and identifies/controls inappropriate resource utilization
• Facilitates patient and family education and promotes continuity of care to achieve optimal patient outcomes
• Assures patient rights by offering a choice when appropriate
• Reviews the patient plan of care with the multi-disciplinary team
• Facilitates and participates in multi-disciplinary team care conferences for patients with complex problems
• Communicates in the medical record and verbally with the team to coordinate interventions and facilitate continuity of care
• Daily communication and collaboration with the patient care staff to provide continuous assessment, evaluation, and continuum planning to assure the patient receives the appropriate level of care at the appropriate time
• Facilitates the implementation of nursing interventions as indicated by the multi-disciplinary team plan of care that enhances and compliments the skill level of the nursing staff
• Functions without direct supervision, utilizing time constructively and organizing assignments for maximum productivity
• Arranges schedule to facilitate meetings with physicians for patient care rounds, team meetings and other opportunities to improve communication
• Adheres to name badge/dress code compliance
• Utilization Management Knowledge of all applicable federal and state regulations
• Demonstrates a working knowledge of managed care and Medicare health plans as well as reimbursement related to post-acute services within the continuum of care
• Consults with physician section leaders for support in cases that continued stay is not appropriate, and case manager is unable to come to resolution by working with assigned physician
• Responsible for communicating with the department director LOS and financial information, as well as issues that may affect the continuum of care process
• Continuum Of Care Planning: CM will be responsible for integrating the assessment of the need for post-hospital services and determination of an appropriate discharge plan for complex cases
• Edits patient/family as to options/choices within the level of care determined to be appropriate
• Initiates and ensures completion of all necessary paperwork
• Facilitates completion of orders as required prior to transfer of patient to the next level of care in a timely manner so discharge is not delayed
• Continuum of Care planning will emphasize education and collaboration with physicians, family members, clinical social workers, nursing staff, therapists, and case managers from contracted payors when appropriate to determine discharge plan that will be of maximum benefit to the patient
• Involves staff from next level of care in the treatment plan as early as possible to promote continuity and collaboration
• Reports on all relevant information to the staff assuming responsibility in the next level of care

Required Qualifications

• Current, unrestricted Registered Nurse license in the state of Maine
• 3+ years of experience in a hospital, acute care, or direct care setting
• Intermediate level of proficiency to type and navigate a Windows based environment
• Bachelor's Degree (or higher) in Nursing (BSN)
• Certified Case Manager (CCM) and/or American Case Management Certification (ACM)
• Experience or exposure to discharge planning
• Experience in utilization review and concurrent review
• Knowledge/understanding of community resources, policies, and procedures
• Knowledge of Utilization Review, Medicare Requirements processes as well as State and Federal regulations pertaining to Utilization Review and Discharge Planning
• Cerner EMR experience

Preferred Qualifications

• Case management experience

Soft Skills

• Solid analytical, critical thinking and organizational skills

Pay

The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life.